Neuropsychiatric Changes Research Articles

Deep Brain Stimulation: Inducing Self-Estrangement

Despite growing evidence that a significant number of patients living with Parkison’s disease experience neuropsychiatric changes following Deep Brain Stimulation (DBS) treatment, the phenomenon remains poorly understood and largely unexplored in the literature. To shed new light on this phenomenon, we used qualitative methods grounded in phenomenology to conduct in-depth, semi-structured interviews with 17 patients living with Parkinson’s Disease who had undergone DBS. Our study found that patients appear to experience postoperative DBS-induced changes in the form of self-estrangement. Using the insights from patients’ subjective perceptions of postoperative self-change provides a potent explanation of potential DBS-induced self-estrangement.

Kidney-brain axis inflammatory cross-talk: from bench to bedside.

Epidemiologic data suggest that individuals at all stages of chronic kidney disease (CKD) have a higher risk of developing neuropsychiatric disorders, cognitive impairment, and dementia. This risk is generally explained by the high prevalence of both symptomatic and subclinical ischemic cerebrovascular lesions. However, other potential mechanisms, including cytokine/chemokine release, production of reactive oxygen species (ROS), circulating and local formation of trophic factors and of renin-angiotensin system (RAS) molecules, could also be involved, especially in the absence of obvious cerebrovascular disease. In this review, we discuss experimental and clinical evidence for the role of these mechanisms in kidney-brain cross-talk. In addition, we hypothesize potential pathways for the interactions between kidney and brain and their pathophysiological role in neuropsychiatric and cognitive changes found in patients with CKD. Understanding the pathophysiologic interactions between renal impairment and brain function is important in order to minimize the risk for future cognitive impairment and to develop new strategies for innovative pharmacological treatment.

Time trend of neurocysticercosis in children with seizures in a tertiary hospital of western Nepal.

IntroductionNeurocysticercosis is a common cause of seizure disorders in children of Western Nepal. The clinical presentation is variable. The incidence varies depending on the food habits and ethnicity of the population. The present study was undertaken with the objective of studying the mode of presentation, radiological findings and to determine the recent trend of the disease in children of Western Nepal.MethodsRecords from the Department of Pediatrics, Manipal Teaching Hospital, Pokhara, Nepal of children aged 0–17 years admitted from 2003 to 2015 and with the discharge diagnosis of seizure and neurocysticercosis (NCC) were reviewed. The diagnosis was primarily based on clinical features, neurological involvement and CT and MRI studies. Seizures due to other CNS pathologies were excluded. Patients with NCC were treated with Albendazole15mg/kg/day for 28 days with supportive treatments for seizures and raised intracranial pressure. Patients were followed up for one year after the completion of the treatment.ResultsThere were 1355 cases of seizure disorders, out of which 229 (16.90%) were NCC. There were 99 (43.23%) in the age group 6–10 years followed by 91 (41.09%) in the age group of 11–15 years. Seizures were the most common presenting symptom in 88.65%, followed by raised ICP in 9.61%. Neuropsychiatric changes were noted in 38 cases (16.59%). CT scan findings revealed single lesion in 78.16% and multiple lesions in 21.83%. Poisson regression analysis showed statistically significant decline of year-wise incidence of NCC cases (p<0.05) from 2003 to 2015.ConclusionThe decline in the incidence of NCC in recent years is most probably attributed to improved hygiene with the construction of household toilets to avoid open defecation and biannual deworming with Albendazole as a part of School Health and Nutrition Project.

D-Aspartic acid ameliorates painful and neuropsychiatric changes and reduces β-amyloid Aβ1-42 peptide in a long lasting model of neuropathic pain

Depressive symptoms and other neuropsychiatric dysfunctions are common in neurodegenerative disorders, including chronic pain and dementia. A correlation between the β-amyloid protein accumulation and the development of depression has been suggested, however the underlying mechanisms are unknown. d-Aspartate (d-Asp) is a free d-amino acid found in the mammalian brain and involved in neurological and psychiatric processes, such as cognition and affective disorders. In this study we have investigated the effects of a repeated treatment with d-Asp in a long-lasting (12 months) model of neuropathic pain, the spared nerve injury (SNI), in mice. Specifically, we evaluated i) the pain sensitivity and related emotional/cognitive dysfunctions induced by SNI, ii) possible changes in the β-amyloid protein accumulation in specific brain regions involved in pain mechanisms ii) possible changes in steroids level in neuropathic animals with or without d-Asp in the same brain areas.SNI mice showed an increase of the insoluble form of Aβ1-42 at hippocampal level and displayed cognitive impairments, stereotypical and depressive-like behaviours. d-Asp treatment reduced abnormal behaviours and normalized the β-amyloid protein expression. Moreover, d-Asp dramatically increased steroids level measured in the prefrontal cortex and in the hippocampus. Our findings provide new insights into pain mechanisms and suggest a possible role of β-amyloid protein in neuropsychiatric dysfunctions associated with chronic pain.

I Miss Being Me: Phenomenological Effects of Deep Brain Stimulation

The phenomenological effects of deep brain stimulation (DBS) on the self of the patient remains poorly understood and under described in the literature, despite growing evidence that a significant number of patients experience postoperative neuropsychiatric changes. To address this lack of phenomenological evidence, we conducted in-depth, semistructured interviews with 17 patients with Parkinson's disease who had undergone DBS. Exploring the subjective character specific to patients' experience of being implanted gives empirical and conceptual understanding of the potential phenomenon of DBS-induced self-estrangement. Our study concluded that (1) the more patients preoperatively felt alienated by their illness, the more they experienced postoperative self-estrangement, and (2) the notion of self-estrangement seems to exist in association with certain common qualitative characters, namely, loss of control, which reflects a deteriorative estrangement, and distorted perception of capacities, which reveals a restorative estrangement. These findings indicate that subjective self-reports help us to understand some aspects of the potential phenomenon of DBS-induced self-estrangement.

Neurological Autoantibody Prevalence in Epilepsy of Unknown Etiology

Autoimmune epilepsy is an underrecognized condition, and its true incidence is unknown. Identifying patients with an underlying autoimmune origin is critical because these patients' condition may remain refractory to conventional antiseizure medications but may respond to immunotherapy. To determine the prevalence of neurological autoantibodies (Abs) among adult patients with epilepsy of unknown etiology. Consecutive patients presenting to neurology services with new-onset epilepsy or established epilepsy of unknown etiology were identified. Serum samples were tested for autoimmune encephalitis Abs as well as thyroperoxidase (TPO) and glutamic acid decarboxylase 65 (GAD65) Abs. An antibody prevalence in epilepsy (APE) score based on clinical characteristics was assigned prospectively. Data were collected from June 1, 2015, to June 1, 2016. Presence of neurological Abs. A score based on clinical characteristics was assigned to estimate the probability of seropositivity prior to antibody test results. Good seizure outcome was estimated on the basis of significant reduction of seizure frequency at the first follow-up or seizure freedom. Of the 127 patients (68 males and 59 females) enrolled in the study, 15 were subsequently excluded after identification of an alternative diagnosis. Serum Abs suggesting a potential autoimmune etiology were detected in 39 (34.8%) cases. More than 1 Ab was detected in 7 patients (6.3%): 3 (2.7%) had TPO-Ab and voltage-gated potassium channel complex (VGKCc) Ab, 2 (1.8%) had GAD65-Ab and VGKCc-Ab, 1 had TPO-Ab and GAD65-Ab, and 1 had anti-Hu Ab and GAD65-Ab. Thirty-two patients (28.6%) had a single Ab marker. Among 112 patients included in the study, 15 (13.4%) had TPO-Ab, 14 (12.5%) had GAD65-Ab, 12 (10.7%) had VGKCc (4 of whom were positive for leucine-rich glioma-inactivated protein 1 [LGI1] Ab), and 4 (3.6%) had N-methyl-D-aspartate receptor (NMDAR) Ab. Even after excluding TPO-Ab and low-titer GAD65-Ab, Abs strongly suggesting an autoimmune cause of epilepsy were seen in 23 patients (20.5%). Certain clinical features, such as autonomic dysfunction, neuropsychiatric changes, viral prodrome, faciobrachial dystonic spells or facial dyskinesias, and mesial temporal sclerosis abnormality on magnetic resonance imaging, correlated with seropositivity. The APE score was a useful tool in predicting positive serologic findings. Patients who were Ab positive were more likely to have good seizure outcome than were patients with epilepsy of unknown etiology (15 of 23 [65.2%] vs 24 of 89 [27.0%]; odds ratio, 4.8; 95% CI, 1.8-12.9; P = .002). In patients who were seropositive, reduction in seizure frequency was associated with use of immunomodulatory therapy. Among adult patients with epilepsy of unknown etiology, a significant minority had detectable serum Abs suggesting an autoimmune etiology. Certain clinical features (encoded in the APE score) could be used to identify patients with the highest probability of harboring neurological Abs.

Functional Cortical Connectivity is Disturbed in Patients with Cirrhosis Even When Neuropsychometric Performance is Unimpaired

Introduction: Disordered brain connectivity, generally defined as failure of effective functional integration within/between brain areas, is thought to be the core deficit in several mental health disorders. Functional connectivity is the term used to define the temporal synchrony or correlation among signals of two or more segregated regions. Most methods for assessing functional connectivity within EEG analysis investigate the phase-relationships between the signals from different scalp electrodes. The main drawback of most previous methods, however, is that volume conduction of the signal through cortical membranes, scalp and skin may introduce noise in the signal and bias accurate assessment of connectivity. The phase-lag index (PLI) is a new assessment method that discards volume conduction noise. The aim of this study was to investigate EEG functional connectivity, measured by PLI, in a large well-characterized population of patients with cirrhosis. Methods: The study population comprised of 268 patients with cirrhosis (174 men: 94 women: mean [range] age 55.3 [24-81] yr; 67% alcohol-related). The reference population comprised of 137 healthy individuals (73 men: 94 women; mean age 39.2 [17-75] years). Psychometric performance was assessed using the PHES battery. The raw PHES data were adjusted and scored using UK normative values and patients ranked by their composite final score into the following groups: PHES >0; PHES -2 to -0; PHES -4 to -2; and PHES <-4; composite scores of <2SD below mean reference values were considered abnormal. EEG recordings were undertaken for 10 minutes in a state of eyes-closed, relaxed, wakefulness. The PLI was calculated and divided into standardized frequency bands viz.: delta (1–4 Hz), theta (4–8 Hz), alpha (8–12 Hz) and beta (12–32 Hz), employing the implementation from The Neurophysiological Biomarker Toolbox (NBT) (http://www.nbtwiki.net/). Results: Significant EEG changes were observed in patients in whom the PHES would ordinarily be considered normal viz. PHES scores -2 to 0, compared to the reference population: Delta (0.139 ± 0.014 vs. 0.144 ± 0.014; P < 0.01), Alpha (0.141 ± 0.036 vs. 0.154 ± 0.036; P < 0.01) and Beta (0.065 ± 0.008 vs. 0.069 ± 0.011; P < 0.05). More pronounced changes, were observed with increasing psychometric impairment; viz. PHES scores -4 to -2: Delta (0.138 ± 0.012 vs. 0.144 ± 0.014; P < 0.01), Theta (0.117 ± 0.018 vs. 0.103 ± 0.009; P < 0.0001): Alpha (0.124 ± 0.026 vs. 0.154 ± 0.036; P < 0.0001) and Beta (0.062 ± 0.006 vs. 0.069 ± 0.011; P < 0.0001). No significant differences were observed, by cirrhosis aetiology. Significant correlations were observed between the results of the individual psychometric tests and functional connectivity in all but the delta band. Conclusion: Cortical connectivity is disturbed in patients with cirrhosis even when neuropsychometric performance is unimpaired. These finding attests to the spectral nature of the neuropsychiatric changes in this patient population and may provide a new and objective mean for assessments and early identification of clinically relevant hepatic encephalopathy; further validation is needed. The authors have none to declare.

Family Functioning and Communication in Spouses of Patients with Parkinsonism.

BackgroundPatients with parkinsonism exhibit motor symptoms, cognitive impairment, and neuropsychiatric changes, and these symptoms increase caregiver burden. Family dynamics can be influenced by the presence of comorbidities, which is especially important in diseases causing caregiver burden. We investigated the effects of spousal parkinsonism on family functioning and communication.MethodsCouples without parkinsonism, who visited hospital-based family practices, were recruited by 28 family physicians from 22 hospitals between April 2009 and June 2011; patients with parkinsonism and their spouses were recruited from a single institution. The participants completed questionnaires on demographic characteristics, lifestyle factors, family functioning (the Korean version of the Family Adaptation and Cohesion Evaluation Scale [FACES] III), and family communication (the Family Communication Scale of the FACES-IV). We compared family functioning and communication between spouses of the patients with and without parkinsonism.ResultsThe mean family adaptability and cohesion scores of the spouses of the patients with parkinsonism were 23.09±6.48 and 32.40±8.43, respectively, whereas those of the control group were 23.84±5.88 and 34.89±7.59, respectively. Family functioning and family communication were significantly different between the spouses of individuals with and without parkinsonism. After adjusting for age, sex, income, and cardiovascular disease in the logistic regression analysis, family functioning was found to significantly deteriorate in the spouses of patients with parkinsonism but not the control group. Family communication decreased significantly in spouses of patients with parkinsonism.ConclusionFamily functioning and family communication significantly deteriorated in spouses of patients with parkinsonism.

Cognitive Impairments in Children with Systemic Lupus and Neuropsychiatric Lupus

Objective: The aim of the present study was to determine neurocognitive profile in Children with Systemic (SLE) and Neuropsychiatric Lupus (NPSLE) describing differences in the seven cognitive areas proposed by the ACR (attention, memory, visuospatial processing, language, problem solving, processing speed, and executive function) between children with SLE and those with NPSLE and to understand the level of cognitive deterioration in children afflicted by SLE with and without neuropsychiatric changes. Method: Children with SLE and with NPSLE were evaluated using the Wechsler Intelligence Scale for Children (WISC-IV) and some selected subtests of the Neuropsychological Assessment for Children (NAC), which allowed us to measure the 7 cognitive areas proposed by the ACR. Both, SLE and NPSLE children performances were compared to scores obtained by children without any affection. Results: The area’s most affected in the NPSLE group were attention, working memory, processing speed, memory, and visuospatial ability; in the SLE group, the area’s most affected were processing speed, visuospatial ability, planning, and auditory memory. Conclusion: Based on our findings, it is concluded that frequently in both groups cognitive decline is present since early stages of illness, being more important in the NPSLE group. These deficiencies are heterogenous and with a multi-domain pattern.

Gender differences in aggression and cortisol levels in zebrafish subjected to unpredictable chronic stress

Chronic stress may cause physical, behavioral and neuropsychiatric changes, affecting the health condition of an individual. Aggression is a universal behavior with great relevance on human and animal social systems. Despite studies showing the influence of chronic stress on aggression, the effects of unpredictable chronic stress (UCS) on aggressive behavior in male and female zebrafish remain unknown. Thus, the aim of this study was to evaluate the effects of UCS on the aggressive behavior and cortisol levels in adult zebrafish of both sexes. Our results showed that UCS increased aggression in males, but not in females, which displayed more aggressive behavior at baseline than control males. Increased whole-body cortisol levels were observed in stressed males; however, no differences were found between female groups. In conclusion, we reported for the first time gender differences on behavioral parameters and cortisol levels in response to UCS in zebrafish. These results highlight the relevance of studying behavioral and physiological parameters in both sexes separately.

Alterations in anxiety and social behaviour in Npas4 deficient mice following photochemically-induced focal cortical stroke

In addition to causing widespread cell death and loss of brain function, cerebral ischaemia also induces extensive neuroplasticity. In humans, stroke is often accompanied by severe cognitive and psychiatric changes that are thought to arise as a consequence of this infarct-induced remodelling. A candidate for producing these post-stroke neuropsychiatric changes is Npas4, an activity-dependent transcription factor involved in synaptic plasticity whose expression is aberrantly up-regulated following ischaemic injury. In this study we investigated the role of Npas4 in modulating these stroke-induced neuropsychiatric responses by comparing the performance of wildtype and Npas4−/− mice in various cognitive and behavioural tasks in a photochemical model of focal cortical stroke. We show that this stroke model results in impaired spatial recognition memory and a reduction in despair-like behaviour that affect both genotypes to a similar degree. Moreover, mice lacking Npas4 also show differences in some aspects of post-stroke sociability and anxiety. Specifically, we show that while stroke had no effect on anxiety levels in wildtype mice, Npas4−/− mice became significantly more anxious following stroke. In addition, Npas4−/− mice retained a greater level of sociability in the acute post-stroke period in comparison to their wildtype littermates. Thus, our findings suggest that Npas4 may be involved in post-stroke psychiatric changes related to anxiety and sociability.

THE LONGITUDINAL INTERPLAY OF BEHAVIORAL SYMPTOMS AND FUNCTIONAL DECLINE IN FRONTOTEMPORAL DEMENTIA

Background: Frontotemporal dementia (FTD) presents with marked neuropsychiatric symptoms that impacts negatively on activities of daily living (ADLs). The relationship between neuropsychiatric symptoms and disability in FTD is not well understood. This study aimed to (1) describe baseline function and neuropsychiatric symptoms in behavioural variant FTD (bvFTD) and semantic variant primary progressive aphasia (svPPA); (2) examine longitudinal functional and neuropsychiatric symptom changes; and (3) examine whether function and neuropsychiatric symptoms are associated longitudinally. Methods: 39 people (bvFTD=21; svPPA=18) were seen annually on two to four visits between 2007-2012, with 200 assessments completed in total. The Disability Assessment for Dementia (DAD) assessed function, Cambridge Behavioural Inventory-Revised (CBI-R) evaluated neuropsychiatric symptoms , and Addenbrooke’s Cognitive Examination Revised (ACE-R) measured general cognition. Results: At baseline, people with bvFTD were more impaired functionally than svPPA despite having higher cognitive scores. In terms of baseline neuropsychiatric symptoms, bvFTD showed higher levels of apathy and changes to eating habits, whereas there was no difference in disinhibited or stereotypical behaviours between the groups. Longitudinally, both groups showed functional decline, however bvFTD remained worse than svPPA over time. Apathy and eating changes increased for both groups. Over time, disinhibited and stereotypical behaviours reduced in bvFTD, yet continued to increase for svPPA. Apathy and stereotypical behaviour were associated with functional decline in bvFTD, whereas only apathy made longitudinal contributions to functional disability in svPPA. Conclusions: People with bvFTD are more functionally impaired than svPPA, and despite overlapping baseline neuropsychiatric symptoms, these dissociate over time, with disinhibition and stereotypical behaviour reducing in people with bvFTD and increasing in svPPA. For both bvFTD and svPPA, apathy has a strong role in disability, but stereotypical behaviors only contributed to functional deficits in bvFTD. Aligning with previous clinical observations, our findings suggest that rigid/compulsive behaviors may in fact support activity engagement in svPPA (O'Connor et al. Disability & Rehabilitation 2016). Overall, our results indicate that interventions to address functional disability in FTD should carefully weigh the interaction of neuropsychiatric symptoms and functional status, thus require a tailored approach which may differ from those used in AD dementia.

Fragile X-Associated Tremor/Ataxia Syndrome (FXTAS) Motor Dysfunction Modeled in Mice.

Fragile X-associated tremor/ataxia syndrome (FXTAS) is a late-onset neurodegenerative disorder that affects some carriers of the fragile X premutation (PM). In PM carriers, there is a moderate expansion of a CGG trinucleotide sequence (55-200 repeats) in the fragile X gene (FMR1) leading to increased FMR1 mRNA and small to moderate decreases in the fragile X mental retardation protein (FMRP) expression. The key symptoms of FXTAS include cerebellar gait ataxia, kinetic tremor, sensorimotor deficits, neuropsychiatric changes, and dementia. While the specific trigger(s) that causes PM carriers to progress to FXTAS pathogenesis remains elusive, the use of animal models has shed light on the underlying neurobiology of the altered pathways involved in disease development. In this review, we examine the current use of mouse models to study PM and FXTAS, focusing on recent advances in the field. Specifically, we will discuss the construct, face, and predictive validities of these PM mouse models, the insights into the underlying disease mechanisms, and potential treatments.

Laboratory assessment of vitamin B12 status

The detection and correction of vitamin B12 (B12) deficiency prevents megaloblastic anaemia and potentially irreversible neuropathy and neuropsychiatric changes. B12 status is commonly estimated using the abundance of the vitamin...

Structural and Maturational Covariance in Early Childhood Brain Development.

Brain structural covariance networks (SCNs) composed of regions with correlated variation are altered in neuropsychiatric disease and change with age. Little is known about the development of SCNs in early childhood, a period of rapid cortical growth. We investigated the development of structural and maturational covariance networks, including default, dorsal attention, primary visual and sensorimotor networks in a longitudinal population of 118 children after birth to 2 years old and compared them with intrinsic functional connectivity networks. We found that structural covariance of all networks exhibit strong correlations mostly limited to their seed regions. By Age 2, default and dorsal attention structural networks are much less distributed compared with their functional maps. The maturational covariance maps, however, revealed significant couplings in rates of change between distributed regions, which partially recapitulate their functional networks. The structural and maturational covariance of the primary visual and sensorimotor networks shows similar patterns to the corresponding functional networks. Results indicate that functional networks are in place prior to structural networks, that correlated structural patterns in adult may arise in part from coordinated cortical maturation, and that regional co-activation in functional networks may guide and refine the maturation of SCNs over childhood development.

Neuropsychiatric manifestations following acute organophosphate poisoning

Acute muscarinic and nicotinic side effects of organophosphate (OP) poisoning are well known and easily recognized, but neuropsychiatric changes are rarely reported. We are reporting a case of a 22-year-old male who developed psychotic features and motor neuropathy following acute OP poisoning.

Neuropsychiatric Disorders Among Aging Women: Assessing Risk Factors and Tailoring Treatment

The older adult female population is fast growing, and sex differences exist for the majority of psychiatric and cognitive disorders affecting this group. Estradiol, with its variability during the reproductive years, particularly during the menopause transition, and its fall in the postmenopause, plays an important role in women’s risks for neuropsychiatric changes. This review aims to review the evidence related to aging in women and common issues faced, including mood, anxiety, psychotic, and cognitive disorders. Important considerations regarding management of these disorders in aging women will also be addressed.

Neuropsychiatric changes in patients with primary dystonia: influence of pallidal deep brain stimulation

Neuropsychiatric changes in patients with primary dystonia: influence of pallidal deep brain stimulation

Neuropsychiatric Symptoms Predict Functional Status in Alzheimer's Disease.

Cognitive deficits are presumed to be the primary driver of functional impairment in Alzheimer's disease (AD); however, functional impairment is likely multifactorially determined. Our objective was to determine the relative contribution of neuropsychiatric symptoms in predicting ratings of functional status. A total of 223 patients received routine neurological and neuropsychological evaluations and met criteria of probable AD dementia based on the McKhann criteria. Demographic, cognitive, and neuropsychiatric variables were entered in a hierarchical linear regression analysis to predict functional status as measured by the Functional Activities Questionnaire (FAQ). The total model explained 29.7% of the variance (p < 0.001) in FAQ. Importantly, neuropsychiatric variables explained 12.7% of the unique variance, with apathy and sleep as significant contributors. Two neuropsychiatric variables, apathy and changes in sleep/nighttime behaviors, predicted ratings of functional status in AD patients independent of age, global cognition, memory and executive function measures, and depressive symptoms. These results highlight the importance of neuropsychiatric symptoms in understanding and potentially treating the functional limitations so prevalent in AD.

Editorial: Neurological and Psychiatric Disorders in Endocrine Diseases

In the last few decades, a number of reciprocal associations between endocrine system dysfunctions and neurological or psychiatric manifestations have appeared, and only in the minority of the cases this link has been fully elucidated (1). Unfortunately, the complexity, and sometimes also the severity, of the clinical issues and the limited availability of reliable experimental models for the study of the endocrine system–nervous system cross-interactions do not help the fast achievement of scientific progresses. Isolated neurological or psychiatric symptoms as well as more complex disorders can occur in the setting of most endocrine diseases. Such manifestations can be the direct result of hyper- or hyposecretion of hormones from the endocrine glands or may occur as events secondary to the pathogenic mechanisms of the endocrinopathy, like in the case of autoimmunity affecting both endocrine glands and the brain (2). Moreover, the medical or surgical treatment of endocrine diseases can sometimes determine the occurrence of neurological or psychiatric syndromes. Some genetic aberrations can also lead to conditions affecting both the endocrine and the nervous system with a variety of possible manifestations. On the other side, many psychiatric or neurological diseases, including but not limiting to conditions, which affect the hypothalamus or the pituitary gland, may impair the physiological endocrine functions and demonstrate once again the intricate complexity of the psychoneuroendocrine connection. Covering all basic, translational, and clinical aspects in a single Research Topic on the “Neurological and psychiatric disorders in endocrine diseases” cannot be realistically feasible. The scope is simply raising a number of interesting points from experts in the field to bring a contribution to the knowledge and maybe direct future research in this very intriguing area. Thus, we have collected reviews and original research articles, which may speak to a wide audience, including neurologists, psychiatrists, endocrinologists, and basic scientists in neuroscience, endocrinology, and metabolism. In the clinical area, an interesting study assesses the plasma levels of the muscle-derived hormone irisin in anorexic women, without finding any significant correlation between irisin level and physical exercise (3). Another fascinating study analyzes the complexity of psychiatric and personality disorders in women with polycystic ovary syndrome, highlighting the issue of psychological distress in this patient group (4). A comprehensive picture of gender dysphoria, a psychiatric condition, which requires endocrine management, in Ireland is presented (5). In a short review, the most relevant reproductive, neurodevelopmental, and genetic aspects of hypogonadotropic hypogonadal syndromes are outlined (6). A German study indicates that psychopathology significantly predicts quality of life in patients with acromegaly and suggests that depressive symptoms and anxiety, being modifiable factors, may represent relevant targets for a broad treatment intervention in acromegalic patients (7). In a concise review, the psychiatric alterations, the neurocognitive impairment, and the altered quality of life affecting at some extent the majority of the patients with Cushing’s syndrome are summarized, and the authors highlight that resolution of hypercortisolism, a challenging and non-granted achievement, does not always lead to the complete remission of the neuropsychiatric changes or restore the quality of life (8). With an incursion in the surgical field, the complications potentially affecting the laryngeal nerves during thyroid surgery are extensively reviewed, suggesting that still the incidence of laryngeal nerves damage secondary to thyroid surgery cannot be suppressed but may be maintained in a low range with thorough surgical techniques and the use of intraoperative neuromonitoring (9). Three articles address the complex interactions between metabolism and neuropsychiatric symptoms. The first one focuses on biological differences between restrictive anorexia nervosa and constitutional thinness, a controversial concept to describe young girls who follow a normal diet and differ from restrictive anorexia nervosa on a number of endocrine parameters (10). At the opposite of the spectrum, the second one reviews the role of inflammatory processes in the neuropsychiatric comorbidity associated with obesity (11). Finally, the last one summarizes the fascinating link through ghrelin peptides between appetite/reward/growth hormone axis and psychiatric disorders (12).